Provider Demographics
NPI:1841541158
Name:THIERRY, MELISSA J (PA-C)
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:J
Last Name:THIERRY
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 3488
Mailing Address - Street 2:DEPT 05-115
Mailing Address - City:TUPELO
Mailing Address - State:MS
Mailing Address - Zip Code:38803-3488
Mailing Address - Country:US
Mailing Address - Phone:888-818-0563
Mailing Address - Fax:228-284-0622
Practice Address - Street 1:3109 SHORTCUT RD
Practice Address - Street 2:
Practice Address - City:PASCAGOULA
Practice Address - State:MS
Practice Address - Zip Code:39567-1811
Practice Address - Country:US
Practice Address - Phone:228-202-5182
Practice Address - Fax:228-202-5184
Is Sole Proprietor?:No
Enumeration Date:2012-09-26
Last Update Date:2024-10-22
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
VA0110003996363AM0700X
MSPA00343363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical